Lecture 8/Chapter 7 Flashcards

1
Q

Learning objectives

A
  • outpatient, ambulatory, and primary care
  • principles behind patient-centered medical homes and community based primary care
  • reasons for dramatic growth in outpatient services
  • various types of outpatient settings and services
  • role of complementary and alternative medicine
  • primary care delivery in other countries
  • impact of ACA on primary care
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2
Q

outpatient and primary care services

A
  • the terms outpatient and ambulatory are used interchangeably
  • hospitals provided majority of outpatient care
  • independent providers faced capital constraints
  • consumer demand fueled growth of complementary and alternative medicine
  • ACA addresses access for poor and vulnerable
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3
Q

what is outpatient care***

A
  • outpatient services or ambulatory care
  • does not require an overnight stay incurring room and boards cost
  • ambulatory care similar to community medicine because it serves:
  • surrounding community
  • convenience
  • accessibility
  • the most basic outpatient services are physicals and minor treatment in physician office
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4
Q

ambulatory care

A
  • diagnostic and therapeutic services for the walking patient
  • used synonymously with community medicine
  • moving yourself
  • ambulatory care similar to community medicine because it serves:
  • surrounding community
  • convenience
  • accessibility
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5
Q

outpatient services

A
  • services not provided with an overnight stay
  • great growth in outpatient care
  • new settings, types, ownership, services
  • physical exams
  • minor treatment
  • advanced outpatient in a hospital base setting
  • physical exams and minor treatment are the most basic services
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6
Q

scope of outpatient services

A
  • primary care is the foundation for ambulatory health services
  • services other than primary care are an integral part of outpatient services
  • technological advances allow treatments to be provided in ambulatory care settings
  • hospital inpatient services continues to decline since 1980s
  • executives see ambulatory care as an essential, no longer a supplemental service line
  • hospital survival can depend heavily on ambulatory care*
  • competition from health health agencies, ambulatory care, urgent care, outpatient surgery
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7
Q

primary care

A
  • the foundation for ambulatory care
  • plays a central role in a health care delivery system
  • foundation of ambulatory care
  • all primary care is outpatient, but not all outpatient care is primary care* -> emergency room, urgent care treatment, outpatient surgery, rehabilitation, renal dialysis, chemotherapy
  • distinguished from secondary and tertiary care by duration, frequency, and intensity
  • secondary and tertiary care are more complex and specialized
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8
Q

secondary care

A
  • usually short term
  • sporadic consultation from a specialist
  • includes hospitalization
  • routine surgery
  • specialty consultation
  • rehabilitation
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9
Q

tertiary care

A
  • most complex level of care
  • uncommon conditions
  • institution based
  • highly specialized
  • technology driven
  • rendered in large teaching hospitals
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10
Q

health care service frequency

A
  • primary care- 75-85% of population requires only primary care
  • secondary care- 10-12% requires referral to short term secondary care
  • tertiary care- 5-10% require tertiary care
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11
Q

world health organization definition of primary health care

A
  • world health organization (WHO, 1978)
  • essential health care based on scientific acceptable methods
  • universally accessibly and acceptable
  • at an affordable cost
  • to maintain at every developmental stage
  • first level of contact*
  • bringing health care as close as possible to where people live and work
  • as part of a continuing health care process
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12
Q

institute of medicine definition

A
  • IOM define primary care
  • comprehensively addresses any health problem at any stage of patients life
  • coordination ensures a combination of health services to best meet the patients needs
  • continuity of care administered over time
  • emphasizes accessibility and accountability
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13
Q

primary care and the ACA

A
  • four primary care provisions:
  • increased medicare and medicaid payments
  • new incentives for primary care providers working in underserved areas
  • expansion of the health center program and strengthening of the capacity of health centers
  • creation of additional training programs
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14
Q

patient centered medical homes (PCMH)

A
  • team oriented approach for special needs children requiring constant care coordination
  • initially consisted of an interdisciplinary team of physicians and allied health professionals
  • studies demonstrated a positive impact
  • PCMH assessment tools
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15
Q

community oriented primary care elements

A
  • reducing exclusion and social disparities
  • organizing health services around peoples needs
  • integrating health into all sectors
  • pursuing collaborative models of policy dialogue
  • increasing stakeholder participation
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16
Q

primary care providers: US primary care practitioners

A
  • are not restricted to physicians trained in general and family practice
  • includes internal medicine, pediatrics, and obstetrics and gynecology
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17
Q

primary care providers: nonphysician practitioners (NPPs)

A

-nurse practitioners (NPs), physician assistants (PAs), and certified nurse-midwives (CNMs)

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18
Q

growth in outpatient services

A
  • reimbursement
  • technological factors
  • utilization control factors
  • physician practice factors
  • social factors
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19
Q

types of outpatient care settings and methods of delivery

A
  • private practice
  • hospital based services
  • freestanding facilities
  • retail clinics
  • mobile medical, diagnostic, and screenings
  • home health care
  • hospice services
  • ambulatory long term care services
  • public health services
  • community health centers
  • free clinics
  • other clinic
  • telephone access
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20
Q

hospital-based services

A
  • clinical services
  • surgical services
  • emergency services
  • home health care
  • womens services
  • urgent care
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21
Q

freestanding facilities

A
  • walk in clinics
  • urgent care centers
  • surgicenters
  • preferred by patients
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22
Q

mobile medical, diagnostic, and screenings

A

-EMTs and paramedics

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23
Q

hospice services

A
  • comprehensive services for terminally ill with life expectance of 6 months or less
  • staffing on 24 hours basis
  • medical and nursing care
  • access to inpatient care
  • social services and support
  • therapy and access to supplies
  • Two areas of emphasis:
  • palliation (pain management) with psychosocial and spiritual support
  • specific conditions for medicare certification
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24
Q

which of the following had the greatest impact on increasing the QUALITY of health care

A
  • licensing healthcare professionals- improves quality of care
  • medical insurance- improves access
  • government pensions- improved quality of life not healthcare
  • technology- improves quality of care
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25
greatest impact on increasing the cost of health care
-technology
26
ambulatory long term care services
- nursing homes - case management -> coordination and referral and finding the most appropriate care - adult day health care
27
three characteristics of free clinics
- services provided at no charge or nominal charge - clinic not directly supported or operated by a government agency - services delivered by trained volunteer staff
28
complementary and alternative medicine (CAM): reasons for CAM growth
- most seek CAM therapies following Western treatments that have not helped - want to avoid/delay complex surgeries or toxic allopathic treatments - feel in control when empowered with medical and health related information - want practitioners to take time to listen to them
29
complementary and alternative medicine (CAM): national center for complementary and alternative medicines (NCCAM) objectives
- 1. explore complementary and alternative healing practices in the context of rigorous science - 2. train complementary and alternative medicine researchers - 3. disseminate authoritative information to the public and professionals
30
ambulatory
- you can move yourself | - walk in patients
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visits to physicians
- physicians in general and family practice (22.8%) - physicians in internal medicine (13.6%) - pediatrics (11.1%) - obstetrics and gynecology (6.4%) - doctors of osteopathy (6.7%)
32
primary care in united kingdom
-most comprehensive coverage with little or no patient cost sharing
33
primary care in canada
-covers physicians visits but medication coverage varies
34
primary care in australia, new zealand, and germany
-varying degrees of cost sharing
35
Australia, Canada, France, Germany, Switzerland, and the U.S.
- payers typically use fee-for-service payments | - employ performance incentives
36
sweden and iceland
-all places mentions were mostly privatized except iceland and sweden
37
summary
- ambulatory services increased outside the hospital setting - ambulatory services transcend basic and routine primary care services - primary care has become specialized - numerous outpatient services have emerged - a variety of setting for services have developed
38
three elements for understanding primary care
- 1. point of entry - 2. coordination of care - 3. essential care - WHO definition
39
point of entry
- into the health care system where health care is organized around primary care - the first contact a patient makes with the delivery system* - role of a gatekeeper*: patient cannot see a specialist or be admitted without a physician referral - goal: bring it as close to the population as possible
40
point of entry
- into the health care system where health care is organized around primary care - the first contact a patient makes with the delivery system - role of a gatekeeper: patient cannot see a specialist or be admitted without a physician referral - goal: bring it as close to the population as possible
41
coordination of care
- to coordinate health care between patient and the many delivery component of the system - primary care professional serve as advisors, advocates, gatekeepers - meant to ensure continuity and comprehensiveness** - countries geared to primary care have better health levels, satisfaction and lower expenses - primary care helps mitigate the adverse health effects of income inequality
42
essential care
-primary health care is regarded as essential health care
43
goal of primary care
- to optimize population health | - disparities must be minimized to ensure equal care*
44
integrated primary care
-comprehensiveness, coordinated, continuous, seamless
45
comprehensiveness in primary care**
addresses any health problem at any stage of a persons life cycle
46
accessibility in primary care
-ease that a patient can interact with a clinician for any health problem
47
accountability in primary care
- clinical system: - to provide *quality care*, patient satisfaction, use of resources efficiently, behaving ethically - patient: - responsible for own health that they can influence - judicious use of resources
48
growth in outpatient services
- reimbursement - technological factors - utilization control factors - physician practice factors - social factors
49
reasons for outpatient growth: changes in reimbursement
- constraining inpatient services - favoring outpatient services - more reimbursement for outpatients services - incentives outpatient to make hospitals less crowded -> better care for everyone - costs less for the insurer!
50
reasons for outpatient growth: fewer payment restrictions
- surgery, dialysis, chemotherapy | - paid as fee-for-service
51
reasons for outpatient growth: development of new technology
- less invasive procedure -> recovery is short and you can leave same day - quicker recuperation from surgery - pain management -> recover at home
52
reasons for outpatient growth: utilization controls
- managed care restriction on utilization, quicker discharge - prior authorization (precertification) - utilization review - list of hospitals that you are covered for
53
reasons for outpatient growth: social factors
- preference for obtaining services at home or in community based setting, especially long term care - more nurturing environment to recover in - youre not just a number
54
1980-1995- increase in total surgeries performed in outpatient departments
- internet - EHR - technology in general
55
home health
- services brought into the home - nursing care - medication monitoring - bathing - short term rehab (PT, OT, ST) - homemaker service, transportation, medical equip, chores - DME- durable medical equipment -> wheelchairs, oxygen, beds, walkers, commodes - alternative would be institutionalization
56
ambulatory long term care services
- nursing homes - case management - coordination and referral - finding the most appropriate care - adult day health care
57
public health service
- immunization to a full range of inpatient and outpatient services - from preventive service to treatment
58
public and voluntary clinics
- community health centers - free clinics - other clinics
59
coordinating in primary care
-combining health services to best meet the patients needs
60
continuity in primary care
-care over time